论病人的“选医权”

选医权是病人的一项基本权力,它能消除医患间事实上的不平等,具有公平的法律价值,能够保证起点公平、过程公平和结果公平。在实施选医权的过程中,病人要正确行使权力,不能滥用权力,履行自己应尽的义务;医院和医生必须为保证病人选医权履行相应的义务。     

病人的价值取向在诊疗决策中的作用

病人在诊疗中的自主性是医学发展及病人权利意识增长的产物,它有利于尊重病人的权利及人格,使病人对诊疗有更好的认同和依从性,提升诊疗效果和减少医疗纠纷,但尊重病人的自主性也有一定的限度,医生有特殊干涉权。     

病人的价值取向在诊疗决策中的作用

病人在诊疗中的自主性是医学发展及病人权利意识增长的产物,它有利于尊重病人的权利及人格,使病人对诊疗有更好的认同和依从性,提升诊疗效果和减少医疗纠纷,但尊重病人的自主性也有一定的限度,医生有特殊干涉权.     

中国传统医疗父爱主义及其当代价值

中国传统医疗模式强调医生基于患者利益,为患者做主,病人在医患关系中处于被动服从地位。这是由于医生具有专业知识的优势,只有医生才能做出有利于病人的决策。这种医疗模式具有父爱主义的特点,但它同时也意味着对病人权利的忽视。因此,它最终被以尊重自主原则为核心的医疗自由主义传统所取代。但是医疗自由主义在片面强调病人自主性的同时,却忽视了医生的德性,产生了新的医患矛盾。面对今天临床医学实践中的困境,我们有必要重新审视病人自主的至高无上地位以及废弃已久的医疗父爱主义的当代价值。传统医患和谐关系中有很多值得发掘的有利因素,医疗父爱主义有利于增强医者的责任意识,重塑医家美德,从而缓和医患关系,促进医患和谐。     

精神科复诊的处理

当精神科复诊病人主诉疗效不好、不良反应或药价太贵时,精神科医生应当做些什么,同时,能否处理好医、患、药之间的相互关系,对病人的病情转归都有十分重要的影响.     

医学专业精神及医疗保密：美国历史及现状中的冲突

讨论卫生部门宣传和加强强制汇报的法律的努力、强制性汇报的规定与医学专业精神及个人自主性之间的冲突、私人医生避免遵守这些规则的策略、病人和倡议者设法避免强制性登记和检测的策略,以及医生/病人和公共卫生官员达成的妥协。最后对公共卫生政策提出建议,认识到强制性汇报存在的问题和卫生政策透明度的重要性。     

医学专业精神及医疗保密:美国历史及现状中的冲突

讨论卫生部门宣传和加强强制汇报的法律的努力、强制性汇报的规定与医学专业精神及个人自主性之间的冲突、私人医生避免遵守这些规则的策略、病人和倡议者设法避免强制性登记和检测的策略,以及医生/病人和公共卫生官员达成的妥协.最后对公共卫生政策提出建议,认识到强制性汇报存在的问题和卫生政策透明度的重要性.     

患者的自主权及困境

在生命伦理学中,尊重自主性原则是指尊重病人或受试者的自主性,可理解为病人自主原则。自主性的实现涉及到自主性的人与自主性的选择,面对复杂的医疗情境,患者自主权的实施面临着重重困境。从自主、病人自主原则、病人自主的实践三个层面讨论了该原则,并尝试用境遇伦理学原理来解决病人自主原则的实践困境。     

名垂千古的医德

古希腊著名医生、欧洲医学奠基人、被尊为“医学之父”的希波克拉特斯(约公元前460年—377年),制定了医生必须遵守的道德规范,至今虽两千多年,但仍具有深远影响。一九四八年,世界医协大会通过的日内瓦宣言,就是以希波克拉特斯的医生道德规范为篮本起草的。一九四九年,世界医协大会又通过决议,把它作为国际医务道德规则。希波克拉特斯的医生道德规范是: 一、对授业之师,敬若父     

医乃仁术：中国医学职业伦理的基本原则

中国古代医学道德具有悠久的传统和独特的价值体系。中国医学史上著名的“医乃仁术”的命题,充分体现了医疗实践的伦理价值。它不仅反映了医学技术是“生生之具、活人之术”,而且也表达了中国古代医生的道德信念,即通过行医施药来实现仁爱爱人。济世救人的理想。中国传统医学十分重视医学的伦理价值,“医乃仁术”被普遍信奉为职业伦理原则。然而,尽管历代医家也提出过一些医学伦理准则和规范,但并未形成一个类似于西方医学史上“希波克拉底誓词”那样具有普遍约束力的、公认的誓言和准则。“医乃仁术”的普遍原则更多的是体现在强调医…     

Beyond Mental Competence

Justification for psychiatric paternalism is most easily established where mental illness renders the person mentally incompetent, depriving him of the capacity for rational agency and for autonomy, hence undermining the basis for liberal rights against paternalism. But some philosophers, and no doubt some doctors, have been deeply concerned by the inadequacy of the concept of mental incompetence to encapsulate some apparently appealing cases for psychiatric paternalism. We ought to view mental incompetence as just one subset of a broader justification for psychiatric paternalism. The very basis of liberal limitations on psychiatric paternalism, whether described in terms of rights to autonomy or as respect for differences in values and lifestyles, presupposes a sense of moral persistence, and hence some sufficiently persistent self. Paternalistic intervention is warranted when we are unable to govern our lives in a manner consistent with the goals and values that comprise that ‘self’. One way that can occur is when we lack the mental capacities required for autonomy, such that we are unable to interpret and interact with our environment in order to meaningfully pursue our goals, i.e. mental incompetence. But it can also occur when we are subject to impositions that alter our goals without altering our capacity to pursue them — i.e. when it is our ‘self’ that is impaired rather than our competence.     

Different standards are not double standards: all elective surgical patients are not alike

Testa and colleagues argue that evaluation for suitability for living donor surgery is rooted in paternalism in contrast with the evaluation for most operative interventions, which is rooted in the autonomy of patients. We examine two key ethical concepts that Testa and colleagues use: paternalism and autonomy, and two related ethical concepts: moral agency and shared decision making. We show that by moving the conversation from paternalism, negative autonomy, and informed consent to moral agency, relational autonomy, and shared decision making, one better understands why the arguments given by Testa and colleagues fail. We argue (1) why the hurdles that one must overcome to become a living donor are appropriate; and (2) that the similarities between living donor transplant surgery and cosmetic plastic surgery that the authors describe are inaccurate. Finally, we consider the recommendation to treat plastic surgery patients and living donors more similarly. We argue that any change should not be in the direction of becoming less protective of living donors, but more protective of cosmetic plastic surgery candidates.     

Governing [through] Autonomy. The Moral and Legal Limits of “Soft Paternalism”

Legal restrictions of the right to self-determination increasingly pretend to be compatible with the liberal concept of autonomy: they act upon a ‘soft’ or autonomy-orientated paternalistic rationale. Conventional liberal critique of paternalism turns out to be insensitive to the intricate normative problems following from ‘soft’ or ‘libertarian’ paternalism. In fact, these autonomy-oriented forms of paternalism could actually be even more problematic and may infringe liberty rights even more intensely than hard paternalistic regulation. This paper contributes to the systematic differentiation of soft and hard paternalism by discussing the (legal) concept of autonomy and elaborates the moral and legal limits of autonomy-orientated paternalism.     

Bioethics reformation style

The Hippocratic model is inadequate because it is too paternalistic, argues Rebecca D. Pentz in her response to Cameron. Instead, we would do well to think of the patient/doctor relationship in Reformation terms, using the pastor/congregation relationship as a model. Rejecting Hippocratic paternalism is not tantamount to an assertion of absolute autonomy; it entails patient responsibility, shared with the physician.     

临床麻醉中知情同意的思考

临床麻醉工作中,尊重患者自主权是知情同意的基础,知情同意反映了患者自主权与医学干涉主义之间的相互妥协。在信任基础上的知情同意,是患者自主权的最佳体现,也是对医学干涉主义的尊重,从而为患者的利益提供服务。     

Patient choices, family interests, and physician obligations

Recent articles in biomedical ethics have begun to explore both the relevance of family interests in treatment decisions and the resultant ramifications for physicians' obligations to patients. This article addresses two important questions regarding physicians' obligations vis-a-vis family interests: (1) What should a physician do when the exercise of patient autonomy threatens to negate the patient's moral obligations to other family members? (2) Does respect for patient autonomy typically require efforts on the part of physicians to keep patients' treatment decisions from being influenced by family considerations? A series of clarifications about the concept of autonomy is also presented.     

Living donation and cosmetic surgery: a double standard in medical ethics?

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.     

Autonomy and coercion in disease prevention and health promotion

Most of the attention regarding the balance between autonomy and paternalism has been focused on the therapeutic relation. Much less attention has been devoted to the problem of autonomy in the application of medical knowledge for preventive purposes. Here, because the good to be achieved is social as well as individual, an unavoidable dilemma ensues. Effective preventive measures of benefit to all must necessarily limit autonomy and involve some coercion. I argue that there are principles which can be established to guide society in a moral use of coercion. The question of employing medical knowledge is not, as it is in therapeutic medicine, to preserve or enhance autonomy. Rather its aim is to enhance voluntary co-operation. Principles for moral use of coercion must thereby be derived from health as a moral value.     

Autonomy, Slavery, and Mill's Critique of Paternalism

Critics have charged that John Stuart Mill's discussion as of paternalism in On Liberty is internally inconsistent, noting, for example, the numerous instances in which Mill explicitly endorses examples of paternalistic coercion. Similarly, commentators have noted an apparent contradiction between Mill's political liberalism – according to which the state should be neutral among competing conceptions of the good – and Mill's condemnation of non-autonomous ways of life, such as that of a servile wife. More generally, critics have argued that while Mill professes an allegiance to utilitarianism, he actually abandons it in favor of a view that values personal autonomy as the greatest intrinsic good. This paper presents an interpretation of Mill that provides a viable and consistent treatment of paternalism, thereby refuting each of the aforementioned critiques. Mill's views, it argues, are consistently utilitarian. Moreover, the interpretation accounts for all of Mill's departures from his otherwise blanket prohibition of paternalistic legislation. In particular, it explains his most notorious example, the condemnation of voluntary contracts for slavery. The interpretation emphasizes Mill's conceptual linkage between autonomy and utility, noting his implicit use of at least three different senses of the notion of autonomy.